Love in Mexico

This blog documents the encounters and events that taught me about Mexico, and about the culture of family, Mexico's and my own.
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A Healthy Body Politic? Vaccines in Mexico

“Un momento,” called A’s teacher Anita as we strollered away from his Montessori school one afternoon.

When she caught up, she handed my husband a small slip of white paper printed faintly on one side.

“Today they came to give vaccinations. A had one for polio. They said that he wouldn’t have any reaction to it.”

My husband and I looked at the slip of paper a little dumbly. We nodded.

“Una vacuna,” I echoed.

“Only drops,” Anita reassured me. Then, because she’s figured out by now that I only understand about half of what I’m told in Spanish, she repeated herself. “And they said he wouldn’t have any reaction.”

I had heard about a vaccination campaign underway, because when I had taken my newborn for his February 4th appointment (scheduled for the day, but at no particular time), the Secretaria de Salud was out of vaccines and told me to come back later. I had not imagined, however, that the campaign would go so far as to canvas places in the community where children would be, including a private preschool.

We did not ask who “they” were—I knew it was some arm of the public health system, probably the Secretaria de Salud, as Mexico’s health ministry is called. We did not ask why our son had been vaccinated for something his shot record clearly indicated he’d already had—this is Mexico and I am resigned to a wider margin of error. Nor did I ask why I hadn’t been informed or my permission sought ahead of time: in Mexico, public health is, well, public. And it isn’t up to me as a parent, an individual, when the health of the public is at stake.

Fortunately, I love vaccines. Last year, when H1N1 cases were being reported at the university daycare where my then eighteen-month-old was supposed to spend his days (though I kept him quarantined at home), I sent my husband out on his bike in the frigid pre-dawn hours to wait in line outside the first clinic in the city offering vaccines to children under two. Of the first 80 doses available to the public, my son received number eight.

But this is me. And I know that far from everyone shares my zeal for needles.

At least in the U.S.

In Mexico, however, where the effects of preventable diseases are not so removed from collective memory, vaccines are a responsibility, a civic duty, and while the enforcement of regulations can be lax in Mexico (see my earlier work on seatbelts and lead-glazed dishes intended for food), vaccine requirements are upheld with a vigilance I haven’t seen applied to any other area.

At my son’s first visit to the pediatrician, we got the lowdown on how vaccines work in Mexico.

“They are required here, without exception,” the doctor explained. “Without them, children cannot get papers or enroll in school or anything else.”

We would have to get a vaccination book and have it certified by the civil registry, he explained. The schedule was different from that in the U.S., and some vaccines, such as tuberculosis, were not the same. Vaccines are given at public clinics, without cost.

“But it’s a good thing,” the doctor added. “I used to see babies with rotavirus all the time, and it was really awful. Then, about five years ago, they started vaccinating. I haven’t seen a case since.”

Yesterday, I returned to the Secretaria de Salud for the baby’s two-month shots. The inside of the building—green walls, some broken tiles, and rows of chairs that people seemed to have been sitting on a long time—looks like a cross between a public elementary school and a bus station. People go to the Secretaria for routine care: handwritten posters hang on the wall with information about prenatal classes and help for post-partum depression.

My sister, who is visiting, and I stood in line with other families to sign in at a desk, and we couldn’t help making a joke or two about how coming to the crowded Secretaria offered more opportunities for acquiring antibodies than by vaccine. We stood out, of course, not only because we were blathering in rapid-fire English or because my sister’s handbag so clearly cost a few months of a well-employed Mexican’s salary, but because I was carrying my baby wrapped to my chest instead of cradling him in my arms; worse yet, since it was sunny and in the 70s outside, I had not shrouded him in blankets. This is to say that judgment is a two-way street and we received as well as we gave.

The line moved slowly as the woman stamping vaccine booklets hand-entered everyone’s information on a large ledger sheet. Name of baby. Age. Address. District.

My son would get the DPaT series and his first Hep B. Neumocócica and rotavirus were not available; we’d have to take him to another center for those.

Stamp. Stamp.

Then we moved on to another line, this one much shorter, at the door marked “VACUNAS” with another handmade poster. Once we were inside, the baby got a needle deep in each leg while I looked out a high window at the sky.

Outside a moment later we bought churros from one of the clustered vendors selling sweets and balloons for teary children (or their teary mothers) and made a beeline for the pretty plaza across the street. I nursed the baby on a park bench while my sister snapped pictures with her iPod—a pigeon on the statue’s head, the clouds of balloons outside the Secretaria, me and my baby—and we talked.

We talked about vaccines, about islands vs. blanket coverage, about privacy and public good, about collective action problems, about rubella (my favorite example of why vaccines are not about the individuals who get them, since rubella itself is not much of a disease, but fetuses exposed during early pregnancy develop into blind children), and about tuberculosis, which is the first vaccine babies get in Mexico.

As I say this, I remember that I’d been warned that the blistering might occur weeks later. So I ran my finger over baby’s tiny arm. And, indeed, was that a bump? A bump that would become his first scar?

It was.

I shuddered.

But then I got control of myself. After all, my son was already part of Mexico’s collective self-improvement. He is, I realized, a Mexican citizen in more ways than merely the place of his birth.

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Comments

Congrats on the EP! I've noticed the viligance of providing vaccines here in Oaxaca as well. Even other health-related issues are promoted strongly. During the rainy season last year there was a small outbreak of dengue....no deaths, but terrible sickness. Workers from la Secretaria de Salud were going from house to house to inquire on the health of everyone in the home, to check for standing water and if standing water was found to dump some type of chemical in it to kill off any mosquitos. I was quite impressed.

I have friends who skipped some of the vaccines; it was all the rage at stay-home-moms groups a few years ago to endlessly talk this to death. I never did understand how you could justify not only taking the chance of your child getting sick, but of making other kids sick.

I don't understand how people can not get the shots for their children. You here on Oprah some star, without a medical degree, claiming how they are killing our kids.

Since nothing is perfect, let's say that some kids do get sick from the shots. What are the odds? 600 to 1? More? Look at measles death rates in places where you can not get vaccinations. According to WHO in 2008, 83% of children in the world got a measles vaccination by the time they were one. From 2000 to 2008 the death rate dropped 78% due to increased vaccination rates.

In 2008 WHO reported 18 people PER HOUR died of measles even after that huge drop. If you want to play roulette with your child's life, just plop him down on 13 black and spin the ball.

Thanks for another reminder of what we don't want exported to the U.S.: a universal healthcare system full of mandates, no exceptions, one size fits all vaccine programs [I hear the screams beginning now as everybody reacts differently to medicines and vaccinations.] And most of all to that wide margin of error you have so graciously embraced. It is this type of mentality we will not accept in the U.S. An excellent look into what could have been our future.

My daughter's TB scar is a raised lump the size (and color) of a large kidney bean. It hasn't gone away, and given that she's a teenager, probably never will. She thinks it's really ugly.

TB vaccines are effective in something like 60% of the individual vaccinated, although more effective in smaller children. If you are vaccinated, you will be positive on a tine test, readable by anyone. You will need a Mantoux test, which requires a doctor to read it, to tell the difference between immunity due to an active case of TB and immunity due to vaccination. Since the vaccination effectiveness is not all that great, many places (like my kids' school) require a Mantoux, rather than just proof of vaccination.

Having lived in England, I note that public health systems do much, much better with babies and public health than our patchwork, insurance-driven system.

Very interesting. I don't know how I'd feel about my child randomly being vaccinated at his school - but like you I am overall very much in favor of preventative medicine. I'm glad you live in a country where this is available at no cost, to all.

With all of the sound-byte debate back home, it's interesting to be able to experience a public health system--albeit one that is uniquely Mexican--up close. It isn't a panacea, of course, and this model would chafe with Americans' resistance to orders from on high well, but it's popular here, and it does a lot to prevent the lily pad phenomenon (pockets of wealth and health floating on swamps) that has historically divided many Latin American countries.

@Malusinka-I've been hearing about the scars and the tests required for school. Ugh.

I've also been hearing since I posted this how US employers assume Mexican workers (and people from other countries that require the vax) test positive because they've been exposed to TB because, well, it's Mexico and they associate that with dirt and sickness, not with a rigorous public health system.

Americans tend to be sure that their policies are the best, so they assume there's no reason to vaccinate for TB (or maybe that there isn't a vaccine) and that you have to vaccinate for chicken pox, which few other countries do.

In Europe, it's much easier and cheaper to visit or work in a different country, so people are more exposed to different ways of doing things.

You just need to tell your kids and your school that your child has been vaccinated.

On the plus side, I've been told that a visible scar of the sort my daughter has, is associated with very strong immunity to TB.

While it's true that vaccines have saved many lives and improved quality of life, the down side is that viruses like TB and smallpox have developed resistant strains that are now surfacing as plagues which require stronger and stronger medicines. We have given ourselves some respite, without solving the problem.Thanks for your account!

I did not even know that there WAS a vaccine for TB. And my stepmother is a nurse, and my mother always tests positive for it and has to get chest X-rays because at some point in her childhood she was exposed to it (though never actually got the disease itself.)

And yes, I would have assumed all the Mexicans who have positive TB tests to have been exposed to the disease at some point, not to have been vaccinated against it.

I was part of a group of new stay at home, green, organic, research everything moms. Vaccines were a big issue. It's easy to be skeptical of something you don't understand that gets a lot of mainstream flack from conspiracy theorists and panicked parents of sick children. Wouldn't it be great if we could blame SIDS and ADHD and Autism on something exterior that can easily be avoided. At first I hesistated, at least by not having my newborn get the Hep C vaccination right after breathing her first breath. I waited til she was a year old for that one, and a few others, since these are adult diseases and I didn't want to flood her tiny system. But all the ones aimed at protecting her fragile little life I certainly took seriously, especially after my scientist husband explained how absolutely harmless they are and that they are possibly the greatest invention of all human history. They're not even an invention, they're more of a discovery really, like the discovery of penicillin or Vitamin C. Anyway, I would still be pissed if anything was done to my child without my consent, even if I approved I would at least like to be notified.Finally hats off to you for being so brave and raising your children in Mexico and being so open to another culture and society. It's clear that you hold little judgement and I'm sure your children will appreciate it. Especially becoming bilingual, what an asset for them!